Routine HIV screening in Portugal:clinical impact and cost-effectiveness

Yazdanpanah, Yazdan and Perelman, Julian and DiLorenzo, Madeline A. and Alves, Joana and Barros, Henrique and Mateus, Ceu and Pereira, João and Mansinho, Kamal and Robine, Marion and Park, Ji-Eun and Ross, Eric L. and Losina, Elena and Walensky, Rochelle P. and Noubary, Farzad and Freedberg, Kenneth A. and Paltiel, A. David (2013) Routine HIV screening in Portugal:clinical impact and cost-effectiveness. PLoS ONE, 8 (12). ISSN 1932-6203

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Abstract

OBJECTIVE: To compare the clinical outcomes and cost-effectiveness of routine HIV screening in Portugal to the current practice of targeted and on-demand screening. DESIGN: We used Portuguese national clinical and economic data to conduct a model-based assessment. METHODS: We compared current HIV detection practices to strategies of increasingly frequent routine HIV screening in Portuguese adults aged 18-69. We considered several subpopulations and geographic regions with varying levels of undetected HIV prevalence and incidence. Baseline inputs for the national case included undiagnosed HIV prevalence 0.16%, annual incidence 0.03%, mean population age 43 years, mean CD4 count at care initiation 292 cells/μL, 63% HIV test acceptance, 78% linkage to care, and HIV rapid test cost €6 under the proposed routine screening program. Outcomes included quality-adjusted survival, secondary HIV transmission, cost, and incremental cost-effectiveness. RESULTS: One-time national HIV screening increased HIV-infected survival from 164.09 quality-adjusted life months (QALMs) to 166.83 QALMs compared to current practice and had an incremental cost-effectiveness ratio (ICER) of €28,000 per quality-adjusted life year (QALY). Screening more frequently in higher-risk groups was cost-effective: for example screening annually in men who have sex with men or screening every three years in regions with higher incidence and prevalence produced ICERs of €21,000/QALY and €34,000/QALY, respectively. CONCLUSIONS: One-time HIV screening in the Portuguese national population will increase survival and is cost-effective by international standards. More frequent screening in higher-risk regions and subpopulations is also justified. Given Portugal's challenging economic priorities, we recommend prioritizing screening in higher-risk populations and geographic settings.

Item Type:
Journal Article
Journal or Publication Title:
PLoS ONE
Uncontrolled Keywords:
/dk/atira/pure/subjectarea/asjc/2700
Subjects:
ID Code:
75885
Deposited By:
Deposited On:
21 Oct 2015 05:01
Refereed?:
Yes
Published?:
Published
Last Modified:
13 Nov 2020 10:23